What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (n=12760). Intervention: Marital status (married vs unmarried) vs. Married patients. Primary outcome: In-hospital mortality (OR 4.20, 95% CI 1.93-9.10, p=0.0003).

What does this research mean for the field?

Unmarried patients have a significantly higher risk of in-hospital mortality in acute coronary syndrome, with an odds ratio of 4.20. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 13, 2026Open Access

Association between marital status and in-hospital mortality in patients with acute coronary syndrome: a multivariable logistic regression analysis

Key Result

Being unmarried increased in-hospital mortality risk in ACS patients with OR 4.20 (95% CI 1.93-9.10) compared to married patients during hospitalization.

Key Points

To evaluate the effect of marital status on in-hospital mortality in patients with acute coronary syndrome and develop a predictive scoring system.
Included 12,760 patients with acute coronary syndrome during hospitalization.
Categorized patients into death and survival groups, and further into married and non-married groups.
Conducted multivariable logistic regression analysis to determine the relationship between marital status and in-hospital mortality.
Developed a nomogram scoring system to predict mortality risk based on various clinical variables.
Validated the model's performance using ROC curve analysis and decision curve analysis.
Unmarried patients had a significantly higher risk of in-hospital mortality (OR = 4.20).
The ROC curve indicated high predictive accuracy for the model (AUC = 0.972).
Decision curve analysis showed the model with marital status provided the highest net benefit across threshold probabilities.

Study Design

Type

Cohort (n=12,760)

Multicenter

Structured PICO

Does unmarried status increase in-hospital mortality in patients with acute coronary syndrome?

Population

12,760 consecutive adult patients (age ≥18 years) diagnosed with acute coronary syndrome (ACS) during hospitalization. Exclusion criteria included pregnant patients, concurrent malignant tumors, non-cardiac diseases with expected survival <6 months, severe heart failure (NYHA class III-IV), and end-stage renal disease requiring dialysis.

Intervention

Unmarried status (including single, divorced, and widowed)

Comparator

Married status

Outcome

In-hospital mortalityhard clinical

Unmarried status is an independent risk factor for in-hospital mortality in patients with acute coronary syndrome, highlighting the importance of incorporating psychosocial factors into clinical risk stratification.

Main Result

Effect estimate: OR 4.20 (95% CI 1.93-9.10)

Absolute Event Rate: 5.8% vs 1.1%

p-value: p=0.0003

Limitations

Retrospective single-center design with potential selection and information bias
Broad marital status classification grouping single, divorced and widowed as unmarried
Lack of data on other social support and socioeconomic factors leading to potential residual confounding
No external validation of predictive model limiting generalizability
Temporal bias due to study period spanning 2015-2023 with evolving ACS treatments
Use of ICD-10 codes unable to precisely capture disease severity and phenotypes

Abstract

Background In patients with acute coronary syndrome (ACS), marital status may have a significant impact on the prognosis. However, it remains unclear whether marital status influences in-hospital mortality separately. Objective This study aims to examine the relationship between marital status and in-hospital mortality in ACS patients and to develop a predictive scoring system using a multivariable logistic regression model to evaluate marital status as an independent risk factor for in-hospital mortality. Methods We included 12,760 consecutive patients diagnosed with ACS during hospitalization. Patients were categorized into a death group or a survival group based on in-hospital outcomes, and further divided into married and non-married groups according to their marital status. Clinical data, including age, gender, ACS type, Killip classification, high-sensitivity troponin T (hsTnT), creatinine, and CKMB, were collected. We performed multivariable logistic regression analysis to assess the relationship between marital status and in-hospital mortality, and developed a predictive model. The model's performance was validated using ROC curve analysis and decision curve analysis (DCA). Results Univariate analysis showed that being unmarried was significantly associated with higher in-hospital mortality (OR = 5.40, 95% CI: 3.26–8.95, P 0.0001). Multivariable logistic regression confirmed this association (OR = 4.20, 95% CI: 1.93–9.10, P = 0.0003), indicating that marital status is an independent risk factor for in-hospital mortality. The ROC curve demonstrated a high predictive accuracy for the model, with an AUC of 0.972 (95% CI: 0.957–0.987). Decision curve analysis showed that the model including marital status provided the highest net benefit across most threshold probabilities. Based on these findings, we developed a nomogram scoring system incorporating marital status, age, ACS type, hsTnT, creatinine, CKMB, and Killip classification to predict in-hospital mortality risk. Conclusion The marital status of ACS patients is an important independent predictor of in-hospital mortality. Unmarried patients have a significantly higher risk of in-hospital death.

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